Provider Demographics
NPI:1588209084
Name:OLAFSON, BERTHA GAIL
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:GAIL
Last Name:OLAFSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:FORT TOTTEN
Mailing Address - State:ND
Mailing Address - Zip Code:58335-0480
Mailing Address - Country:US
Mailing Address - Phone:701-766-4236
Mailing Address - Fax:701-766-4878
Practice Address - Street 1:816 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-9998
Practice Address - Country:US
Practice Address - Phone:701-766-4236
Practice Address - Fax:701-766-4878
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30068163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse